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LIFT procedure: postoperative outcomes, risk factors for fistula recurrence and continence impairment

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Abstract

Ligation of the intersphincteric fistula tract has been recently employed as definitive treatment of anal fistulas. However, it carries a potential risk of continence impairment, fistula recurrence, and repeated operations. This study aimed to assess postoperative outcomes related to this procedure and evaluate the potential influence of preoperative and intraoperative features. Patients who underwent LIFT procedure between June 2012 and September 2021 were retrospectively analyzed. Patients were divided according to whether they developed fistula recurrence and on the history of a surgery prior to the LIFT. Preoperative features, postoperative outcomes, and risk factors adverse outcomes were analyzed. Forty-eight patients were included, of which 25 received primary LIFT, being the high transsphincteric fistula pattern the most frequent (62.5%). The median follow-up was 13.3 months, with a recurrence rate of 20.8%, of which the majority presented an intersphincteric fistula pattern (50%); and continence impairment rate of 16.7%. A higher prevalence of diabetes (p = 0.026) and a trend towards a higher prevalence of patients with a history of high transsphincteric fistula (0.052) were observed in the group with fistula recurrence. The history of diabetes and the operation time with a cut-off value ≥ 69 min showed a trend as a risk factors for developing fistula recurrence (0.06) and postoperative continence impairment (0.07), respectively. The LIFT procedure seems to be safe in terms of morbidity, with a reasonable incidence of recurrences, showing better results when it is primarily performed. Preoperative characteristics should be considered as they may impact outcomes.

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Acknowledgements

We thank Prof. Giovanni Maria Romano for reading and reviewing this multicentric retrospective study.

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The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    N. Salgado-Nesme, F. E. Alvarez-Bautista, A. Hoyos-Torres, E. A. Ruiz-Muñoz & O. Vergara-Fernàndez

  2. Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131, Naples, Italy

    F. M. Mongardini & L. Docimo

  3. Department of Colorectal Surgery, Hospital de Especialidades-Centro Médico Nacional Siglo XXI, Mexico City, Mexico

    H. O. Gómez Suastegui, M. F. Rojas Illanes & N. D. Mitre Reyes

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  1. N. Salgado-Nesme
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  2. F. E. Alvarez-Bautista
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  3. F. M. Mongardini
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  4. L. Docimo
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  10. N. D. Mitre Reyes
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Contributions

FEA-B, AH-T, LD, EAR-M, HOGS and MFRI designed this work, collected and interpreted the data, and drafted the manuscript. NDMR, OV-F, NS-N and FMM interpreted data, critically revised the manuscript, and performed overall supervision. All authors contributed to the final approval of the manuscript and agree to be accountable for all aspects related to the accuracy or integrity of the work.

Corresponding author

Correspondence to N. D. Mitre Reyes.

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The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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The study was approved by the Institutional Review Board and was performed in line with the principles of the Declaration of Helsinki.

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Salgado-Nesme, N., Alvarez-Bautista, F.E., Mongardini, F.M. et al. LIFT procedure: postoperative outcomes, risk factors for fistula recurrence and continence impairment. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01818-2

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  • DOI: https://doi.org/10.1007/s13304-024-01818-2

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